Tamoxifen only benefits patients with estrogen receptor-positive (ER+) breast cancer (BC), and those with lymph node involvement (pN+) also require adjuvant chemotherapy, which may cause ovarian failure leading to bone loss. The aim of this preliminary study was to evaluate the changes of BMD after adjuvant chemotherapy in patients with BC. Material and Methods: A group of 14 postmenopausal women (median age 55, range 49–59 years) with ER+, pN+, invasive ductal carcinoma, who had undergone curative surgery, were treated with tamoxifen (20 mg/day) and adjuvant CMF standard regimen. Using DXA (Hologic QDR 4500 C, Waltham, USA) the BMD (g/cm2) at the lumbar (L2-L4) spine (LS) was measured. The following serum biochemical parameters were also measured, before and after (12 months) the treatment: albumin, alkaline phosphatase (AP), blood urea nitrogen (BUN), calcium, cortisol (8 a.m.), osteocalcin, PTH, thyroid stimulating hormone (TSH), and 25-hydroxyvitamin D (25(OH)D). Student's t-test was used and a p-value<0.05 was considered significant. Results: The baseline and post-chemotherapy main biochemical parameters and L-BMD were: albumin: 4.1±0.2 vs. 4.0±0.3 g/dL, p=0.31; AP: 161.2±53.1 vs. 207.0±56.3 U/L, p=0.03; BUN: 14.2±2.3 vs. 15.6±2.9 mg/dL, p=0.17; calcium: 2.4±0.2 vs. 2.3±0.2 mmol/L, p=0.19; cortisol: 526.9±118.6 vs. 579.4±102.1 nmol/L, p=0.22; osteocalcin: 9.7±7.1 vs. 10.6±8.3 ng/mL, p=0.76; PTH: 32.8±21.0 vs. 46.6±22.1 ng/L, p=0.10; TSH: 1.9±0.9 vs. 1.0±0.8 U/mL, p=0.10; 25(OH)D: 31.4±9.6 vs. 39.6±11.3 ng/mL, p=0.05; LS-BMD: 0.981±0.124 vs. 0.886±0.236, p=0.04. Conclusion: In this group of patients with BC a significant reduction in LS-BMD values was observed, together with an increase in AP and 25(OH)D serum levels, while the other biochemical parameters did not change significantly. This study confirms the negative effect of chemotherapy on bone in postmenopausal women, suggesting the need of prevent bone loss despite tamoxifen administration.

Lumbar-spine bone mineral density changes following chemotherapy in women with estrogen receptor-positive breast cancer and lymph node metastasis.

LUMACHI, FRANCO;CAMOZZI, VALENTINA;
2013

Abstract

Tamoxifen only benefits patients with estrogen receptor-positive (ER+) breast cancer (BC), and those with lymph node involvement (pN+) also require adjuvant chemotherapy, which may cause ovarian failure leading to bone loss. The aim of this preliminary study was to evaluate the changes of BMD after adjuvant chemotherapy in patients with BC. Material and Methods: A group of 14 postmenopausal women (median age 55, range 49–59 years) with ER+, pN+, invasive ductal carcinoma, who had undergone curative surgery, were treated with tamoxifen (20 mg/day) and adjuvant CMF standard regimen. Using DXA (Hologic QDR 4500 C, Waltham, USA) the BMD (g/cm2) at the lumbar (L2-L4) spine (LS) was measured. The following serum biochemical parameters were also measured, before and after (12 months) the treatment: albumin, alkaline phosphatase (AP), blood urea nitrogen (BUN), calcium, cortisol (8 a.m.), osteocalcin, PTH, thyroid stimulating hormone (TSH), and 25-hydroxyvitamin D (25(OH)D). Student's t-test was used and a p-value<0.05 was considered significant. Results: The baseline and post-chemotherapy main biochemical parameters and L-BMD were: albumin: 4.1±0.2 vs. 4.0±0.3 g/dL, p=0.31; AP: 161.2±53.1 vs. 207.0±56.3 U/L, p=0.03; BUN: 14.2±2.3 vs. 15.6±2.9 mg/dL, p=0.17; calcium: 2.4±0.2 vs. 2.3±0.2 mmol/L, p=0.19; cortisol: 526.9±118.6 vs. 579.4±102.1 nmol/L, p=0.22; osteocalcin: 9.7±7.1 vs. 10.6±8.3 ng/mL, p=0.76; PTH: 32.8±21.0 vs. 46.6±22.1 ng/L, p=0.10; TSH: 1.9±0.9 vs. 1.0±0.8 U/mL, p=0.10; 25(OH)D: 31.4±9.6 vs. 39.6±11.3 ng/mL, p=0.05; LS-BMD: 0.981±0.124 vs. 0.886±0.236, p=0.04. Conclusion: In this group of patients with BC a significant reduction in LS-BMD values was observed, together with an increase in AP and 25(OH)D serum levels, while the other biochemical parameters did not change significantly. This study confirms the negative effect of chemotherapy on bone in postmenopausal women, suggesting the need of prevent bone loss despite tamoxifen administration.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/2833306
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